BPH (1)

Question 1

How does it present?

Answer 1

• Frequency
• Urgency
• Hesitancy - difficulty starting stream
• Straining
• Nocturia
• Weak/interrupted stream
• Straining
• Terminal dribbling
• Incomplete emptying w/chronic retention

Question 2

What are the investigations to do?

What else causes a raised PSA?

Answer 2

➊ • Abdominal examination - assess for palpable bladder
• DRE
• PSA
• Urine dip - assess infection and haematuria

N.B. PSA is unreliable with a high rate of false positives (75%) and false negatives (15%), therefore may lead to unnecessary further investigations or false reassurance

➋ • Prostate ca.
• Prostatitis
• UTI, vigorous exercise, recent ejaculation

Question 3

Management:
What are the lifestyle changes to make?

What can be given?

What are the surgical options?

Answer 3

➊ • Reduce caffeine + alcohol to reduce urgency/nocturia
• Bladder training

➋ • Tamsulosin (a-blocker)
‣ Main SE of Postural hypotension
• Finasteride (5-a reductase inhibitor)
‣ Main SE of Sexual dysfunction (Low libido and ED)

➌ • Transurethral Resection of Prostate (TURP)
• Open prostatectomy